Understanding Progressive Supranuclear Palsy (PSP)

What is PSP?

Progressive Supranuclear Palsy (PSP) is a rare and progressive neurological condition. As the name suggests, it involves a gradual decline in function. PSP is characterised by a supranuclear gaze palsy, leading to difficulties with vertical eye movements, both upwards and downwards.

With a prevalence of approximately six in every 100,000 people, PSP is as common as motor neurone disease. The PSP Society estimates that around 10,000 people in the UK are currently affected by this condition. Despite its rarity, PSP is often less well-known compared to motor neurone disease, which has received significant media attention.

Symptoms and Diagnosis

Common Symptoms

PSP manifests through a variety of symptoms, some of which can be subtle. Early signs include:

• Bradykinesia: Slowness of movement, which can be noticed as a general slowing down of motor tasks.
• Rigidity: Stiffness in the upper limbs and neck.
• Vision Problems: Issues such as blurred vision, double vision, and difficulty with eye-opening (blepharospasm).

Diagnosing PSP

Distinguishing PSP from Parkinson's disease can be challenging due to overlapping symptoms. The clinical picture typically becomes clearer over time, aiding in diagnosis. Key indicators of PSP include:

• Falls: Frequent falls, often backwards, without prior warning.
• Motor Recklessness: Sudden, uncoordinated movements and impulsivity.
• Eye Movement Issues: Difficulty with vertical gaze, often leading to trouble looking down or up.

Impact on Vision

Visual Difficulties

Vision problems are a significant feature of PSP. Affected individuals may experience:

• Light Sensitivity: Increased sensitivity to light, requiring dimmed lighting or sunglasses, including wraparound types for better light control.
• Difficulty with Eye Movement: Challenges with eye movements, including problems with eye-opening and maintaining eye focus. Prism glasses and treatments like Botox can help manage these symptoms.

Managing Eye Problems

Individuals with PSP may struggle with various eye issues, including:

• Blurred Vision and Double Vision: Early signs often include blurred or double vision.
• Blepharospasm: Difficulty keeping eyelids open, sometimes leading to the appearance of being asleep. Treatments may include Botox injections to improve eye-opening.
• Dirty Tie Syndrome: Difficulty looking down, making it hard to see food on a plate, often resulting in dropping food.

Living with PSP

Managing PSP involves adapting to its symptoms and making necessary adjustments. Regular consultations with healthcare professionals and support groups can provide valuable insights and assistance. Despite the challenges, maintaining a positive outlook and seeking appropriate support can significantly improve quality of life.